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Employee Ownership Interest Form
Please fill out this form to provide some more context on how we can help you begin to plan your business' transition to employee ownership!
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* Indicates required question
What is the name of your business?
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Your answer
When was your business founded?
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MM
/
DD
/
YYYY
How many owners does the business have?
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Your answer
Is the business minority owned?
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Yes
No
How many total employees does your business currently have?
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Your answer
What is the business sector?
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Professional and technical services
Health care and social assistance
Construction
Retail trade
Administrative and waste services
Accommodation and food services
Real estate, rental, and leasing
Finance and insurance
Wholesale trade
Manufacturing
Educational services
Information
Arts, entertainment, and recreation
Transportation and warehousing
Agriculture, forestry, fishing, and hunting
Management of companies and enterprises
Utilities
Mining, quarrying, and oil and gas extraction
Industry not classified
What is the owner's exit timeline?
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Your answer
Why are you interested in transitioning to an employee ownership model?
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Your answer
Are there specific topics you would like to learn more about in the JUMPSTART training?
*
Your answer
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